Using implementation science to increase the use of preoperative Fascia Iliaca Blocks in hip fracture patients
- There are about 30,000 hip fractures yearly in Canada. Opioids are effective at relieving acute pain but have side effects, some of which can be reduced by multimodal analgesia.
- Health Quality Ontario Hip Fracture Care Quality Standards recommends performing peripheral nerve blocks based on evidence that it reduces pain on movement within 30 minutes, risk for pneumonia, time to first mobilization, cost of the analgesic regimen, and postoperative delirium.
- Yet, in a survey in the Greater Toronto Area, 67% of staff emergency physicians and 77% of resident physicians indicated never having performed a nerve block in patients with hip fracture.
- Furthermore, in a chart audit of patients admitted with a hip fracture at St. Michael’s Hospital, <10% received a fascia iliaca block.
- This gap in care highlights the need to improve and sustain the uptake of the administering fascia iliaca blocks pre-operatively.
- We are using evidence and best practices from the field of implementation science to increase and sustain the administration of fascia iliaca blocks pre-operatively in older patients with hip fracture.
- We are using an integrated knowledge translation approach to engage all the stakeholder groups involved in optimal preoperative hip fracture care, including patients, physicians from Geriatric Medicine, Anesthesia, Orthopedics and Emergency Medicine as well as allied health from nursing and pharmacy.
- Based on the information gathered from all stakeholder groups, we are developing a suite of implementation strategies and plan for delivering these strategies.
- The results of this project will aim to develop a plan for operationalizing a suite of implementation strategies. This plan will include recommendations for delivering these strategies, identify resources to support ongoing implementation efforts (e.g., how to guides, key messages/presentations for opinion leaders) and include sustainability recommendations.
Who is this done for?
Clinical researchers based out of St. Michael’s Hospital
Category : TIES Projects
Date : 11 Dec 2019